177618 09/29/2009 F CITY OF CARMEL, INDIANA VENDOR: 362937 Page 1 of 1
ONE CIVIC SQUARE COUSINS TENTS AND MORE LLC
CARMEL, INDIANA 46032 5249 NORTH BRANDYWINE ROAD CHECK AMOUNT: $200.00
SHELBYVILLE IN 46176
CHECK NUMBER: 177618
CHECK DATE: 9129/2009
D EPARTMENT ACCOU P O NUMBER INVOICE NUMBER AMOUNT DESCRIP
1046 4341985 72120090035 200.00 GUEST SPEAKERS
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Cousins Tents and More
5245 North Bra n,dywi nZ RDad
:shed bro I le, In 46136
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Please Provide TaK I.D.
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SEP 0 2009 and
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ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Cousins Tents and More LLC Terms
5249; North Brandywine Road
Shelbyville, IN 46176
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
7/10/09 72120090035 Bounce house rental RF 7/10/09 22189 F 200.00
Total 200.00
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
,20
Clerk- Treasurer
Voucher No. Warrant No.
Cousins Tents and More LLC Allowed 20
9 11 4 Brandywine Roatl
i
ShelbyvilleF1N, 4617.6
In Sum of
*,NOTE NEW ADDRESS
200.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 72120090035 4341985 200.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
24 -Sep 2009
Signature
200.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund